Department of Imaging & Imaging Institute of Rehabilitation and Development of Brain Function, The Second Clinical Medical College of North Sichuan Medical College, Nanchong Central Hospital, Nanchong 637000, China.
Department of Radiology, Langzhong People's Hospital, Nanchong 637000, China.
Neural Plast. 2017;2017:2758097. doi: 10.1155/2017/2758097. Epub 2017 Dec 21.
This meta-analysis aimed to evaluate the therapeutic potential of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) over the contralesional hemisphere on upper limb motor recovery and cortex plasticity after stroke.
Databases of PubMed, Medline, ScienceDirect, Cochrane, and Embase were searched for randomized controlled trials published before Jun 31, 2017. The effect size was evaluated by using the standardized mean difference (SMD) and a 95% confidence interval (CI). Resting motor threshold (rMT) and motor-evoked potential (MEP) were also examined.
Twenty-two studies of 1 Hz LF-rTMS over the contralesional hemisphere were included. Significant efficacy was found on finger flexibility (SMD = 0.75), hand strength (SMD = 0.49), and activity dexterity (SMD = 0.32), but not on body function (SMD = 0.29). The positive changes of rMT (SMD = 0.38 for the affected hemisphere and SMD = -0.83 for the unaffected hemisphere) and MEP (SMD = -1.00 for the affected hemisphere and SMD = 0.57 for the unaffected hemisphere) were also significant.
LF-rTMS as an add-on therapy significantly improved upper limb functional recovery especially the hand after stroke, probably through rebalanced cortical excitability of both hemispheres. Future studies should determine if LF-rTMS alone or in conjunction with practice/training would be more effective.
This trial is registered with unique identifier CRD42016042181.
本荟萃分析旨在评估经颅磁刺激（rTMS）对病灶对侧半球低频重复刺激（LF-rTMS）治疗脑卒中后上肢运动功能恢复和皮质可塑性的潜在疗效。
检索 PubMed、Medline、ScienceDirect、Cochrane 和 Embase 数据库，纳入截止到 2017 年 6 月 31 日发表的随机对照试验。采用标准化均数差（SMD）及其 95%置信区间（CI）评估效应量。同时还检测静息运动阈值（rMT）和运动诱发电位（MEP）。
共纳入 22 项关于 1Hz LF-rTMS 刺激病灶对侧半球的研究。结果显示，手指灵活性（SMD=0.75）、手力量（SMD=0.49）和活动灵巧性（SMD=0.32）有显著改善，但身体功能（SMD=0.29）无明显变化。rMT（患侧半球 SMD=0.38，健侧半球 SMD=-0.83）和 MEP（患侧半球 SMD=-1.00，健侧半球 SMD=0.57）的阳性变化也有显著意义。
LF-rTMS 作为一种附加治疗方法，显著改善了脑卒中后上肢功能的恢复，尤其是手部功能，可能通过重新平衡了两侧半球的皮质兴奋性。未来的研究应确定 LF-rTMS 单独或与练习/训练联合使用是否更有效。
该试验注册号为 CRD42016042181。
